Delayed intestinal obstruction following treatment for cancer

Abstract

A review of 117 patients who have been treated for cancer and subsequently developed 173 episodes of intestinal obstruction has established guidelines for the management of the cancer patient with abdominal distress. Operative intervention is the treatment of choice for intestinal obstruction occurring in a patient previously treated for a malignant neoplasm. Approximately one fourth of such patients will have intestinal obstructions which are not caused by recurrence of, or metastases from, the neoplasm for which they had been previously treated. In these patients, obstruction may be due to a new primary cancer or to nonneoplastic disease. The prognosis for such patients is good, with a long-term survival of 40%. When intestinal obstruction is due to recurrent or metastatic neoplasm, significant palliation may be expected by surgically relieving the intestinal obstruction even when multiple episodes are experienced. The interval of palliation following each subsequent obstruction is, however, of progressively shorter duration. Nonoperative management of these patients has been uniformly unsuccessful. Repeated exploration and bowel resection is indicated for palliation and, on occasion, may be curative even when intestinal obstruction is due to local recurrence of cancer.